No matter what age you are, if you need care and are dependent on the help of others in everyday life, you will often incur high care costs. In this case, you are covered by statutory long-term care insurance: it pays part of the costs incurred for care and support. In this article, we show you how statutory long-term care insurance works and how you can provide further financial protection in the event of needing long-term care.
Statutory long-term care insurance is compulsory insurance. If you live permanently in Germany and are a member of private or statutory health insurance, you are required to take out insurance. These and other important regulations on long-term care insurance are set out in the Eleventh German Social Code (SGB XI). The purpose of long-term care insurance is to provide its members with financial support in the event of a need for long-term care and to enable them to lead a self-determined life. In order to fulfill this task, long-term care insurance covers part of the costs incurred for household help or home care, for example. You bear the part of the costs not covered by the insurance yourself. Private supplementary long-term care insurance protects you from this financial burden.
Health and long-term care insurance benefits come from a single source. In addition, long-term care insurance follows on from health insurance. If you have statutory health insurance, this means that you are automatically covered by your health insurance: You are automatically insured for long-term care through your health insurance. The situation is different for privately insured persons. You must take out private compulsory long-term care insurance.
You will receive long-term care insurance benefits if you submit a corresponding application to your health insurance provider. The prerequisite for benefits is a need for long-term care. “Need for care” means that your abilities and independence are impaired for health reasons to such an extent that you are dependent on outside help for at least six months. If this is the case, the long-term care insurance fund will cover part of the costs incurred for the necessary everyday assistance or care, regardless of your age.
If you are dependent on care temporarily or for a period of less than six months, the long-term care insurance fund will not provide any benefits. In this case, your health insurance fund is responsible and will cover the costs incurred.
Depending on your needs, your care insurance will cover part of the costs for outpatient or inpatient care. If a family member or a person close to you takes care of you, the care insurance fund will pay them a care allowance. The benefits (e.g. the assumption of costs for outpatient care and the care allowance) can be combined. The amount of costs covered by the care insurance fund depends on how severely you are impaired in your abilities and independence. The severity of the impairment is indicated by the so-called care degree.
If you apply for care insurance benefits, your application must be reviewed and the degree of your need for care determined. Your classification and assignment to a care degree are necessary so that the statutory long-term care insurance can determine how severely your independence is restricted and what benefits it will provide.
In order to determine which care level applies in a specific case, an assessment is carried out by a specialist. The assessment is carried out by doctors from the Medical Service (MD for short).
During the assessment to classify the level of care, the assessor pays attention to the following points: The amount of costs covered by the care insurance fund depends on how severely you are impaired in your abilities and independence. The severity of the impairment is indicated by the so-called care level.
Mental and communicative abilities - Can the person being assessed orient themselves in everyday life, make decisions, hold conversations and communicate their needs?
During the care assessment, the assessor evaluates the above points. Depending on how much support the person being assessed needs, they will award a score. The total number of points shows the care insurance company which care level the person being assessed is assigned to.
The number of points awarded during the care assessment can be assigned to one of five care levels. The level of care indicates how much help the person concerned needs and what benefits are provided by the statutory long-term care insurance:
People in need of care should have the opportunity to lead their lives as independently as possible. People in need of care can therefore decide for themselves whether they want to be cared for by professionals or relatives. In both cases, long-term care insurance provides benefits to make the desired form of care financially possible.
However, statutory care insurance does not usually cover all care costs. Those in need of care or their relatives must bear the costs incurred over and above the care insurance allowance themselves. The level of care insurance benefits depends on the type of care required and is set out in the German Social Code (SGB XI).
If you are in need of care and are being cared for on an outpatient basis or in your own home, statutory long-term care insurance will cover part of the care costs incurred. How much the care insurance fund pays depends on your care level. It also depends on whether the care is provided by a trusted person or a professional care service.
If a professional care service provides everyday assistance, the care insurance fund will transfer its share of the costs (so-called benefits in kind) directly to them. If a person of trust provides care, they receive a monthly care allowance. The monthly care allowance is lower than the benefits in kind. However, it is not earmarked for a specific purpose and the carer does not have to explain what they have spent it on.
Benefits for complete care in a nursing home are only provided by the statutory long-term care insurance from care level 2. Your co-payment towards the actual care costs is transferred directly to the care facility. You will have to finance the costs that exceed the statutory care insurance co-payment yourself. The amount of your own contribution varies from region to region and from facility to facility.
Statutory long-term care insurance is financed by the contributions of its members. For this reason, you have to pay a monthly insurance contribution. The amount of the contribution depends on whether you have children or not:
If you are in need of care, statutory long-term care insurance will cover part of the costs incurred for your support and care. This means that you or your family must finance the part of the costs not covered by statutory care insurance yourself.
Depending on the care reform, this can range from several hundred to thousands of euros per month. If you or your relatives do not have the necessary reserves, the need for care will become a major financial and emotional burden.
Your opportunity to solve the care dilemma: Private supplementary long-term care insurance, which extends the protection provided by statutory long-term care insurance. This means that you can take out private supplementary insurance to provide extra protection in the event of needing long-term care. Once taken out, private supplementary insurance covers the care costs that are not covered by statutory long-term care insurance. This protects you and your loved ones from financial risks.
If you would like to take out private supplementary long-term care insurance, you can choose between the following options:
Like health insurance, statutory long-term care insurance is compulsory in Germany. You receive statutory health and long-term care insurance from a single source. This means that you are also insured for long-term care through your statutory health insurer. The contributions you pay for your long-term care insurance are based on your gross income.
In return for your contributions, you will receive a cost subsidy from the statutory long-term care insurance if you need to finance long-term care services. Please note, however, that statutory long-term care insurance only covers part of the care costs. To avoid having to bear the remaining costs yourself, you can take out private supplementary long-term care insurance.
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